Profile

Franco Corno

Born in Turin, he graduated in Medicine and Surgery at the University of Turin.
He specialized then in General and Oncologic Surgery, has mainly developed clinical activity and research in the field of Colonproctology, organizing and participating in numerous congresses in Italy and abroad.

Author of more than 200 scientific papers and publications.
He worked as a researcher and adjunct professor at the Surgical Clinic of Turin.
Currently he employed in their study and for Clinics and Hospitals of the Humanitas Group.

Pelvic floor dysfunction

What is pelvic floor dysfunction?
For most people, having a bowel movement is a seemingly automatic function.
For some individuals, the process of evacuating stool may be difficult.
Symptoms of pelvic floor dysfunction include constipation and the sensation of incomplete emptying of the rectum when having a bowel movement.
Incomplete emptying may result in the individual feeling the need to attempt a bowel movement several times within a short period of time.
Residual stool left in the rectum may slowly seep out of the rectum leading to reports of bowel incontinence.
The process of defecation (having a bowel movement) requires the coordinated effort of different muscles.
The pelvic floor is made up of several muscles that support the rectum like a hammock.
When an individual wants to have a bowel movement the pelvic floor muscles are supposed to relax allowing the rectum to empty.
While the pelvic floor muscles are relaxing, muscles of the abdomen contract to help push the stool out of the rectum.
Individuals with pelvic floor dysfunction have a tendency to contract instead of relax the pelvic floor muscles.
When this happens during an attempted bowel movement, these individuals are effectively pushing against an unyielding muscular wall.

How is pelvic floor dysfunction diagnosed?
The diagnosis of pelvic floor disorder starts with a careful history regarding an individual's symptoms, medical problems and a history of physical or emotional trauma that may be contributing to their problem.
Next the physician examines the patient to identify any physical abnormality.
A defecating proctogram is a study commonly used to demonstrate the functional problem in a person with pelvic floor dysfunction.
During this study, the patient is given an enema of a thick liquid that can be detected with x-ray.
A special x-ray video records the movement of the pelvic floor muscles and the rectum while the individual attempts to empty the liquid from the rectum.
Normally the pelvic floor relaxes allowing the rectum to straighten and the liquid to pass out of the rectum.
This study will demonstrate if the pelvic floor muscles are not relaxing appropriately and preventing passage of the liquid.
The defecating proctogram is also useful to show if the rectum is folding in on itself (rectal prolapse).
Many women have outpouching of the rectum known as a rectocele.
Usually a rectocele does not affect the passage of stool.
In some instances, however, stool may become trapped in a rectocele causing symptoms of incomplete evacuation.
The defecating proctogram helps to identify if liquid is getting trapped in a rectocele when the individual is trying to empty the rectum.

How is pelvic floor dysfunction treated?
Pelvic floor dysfunction due to non-relaxation of the pelvic floor muscles may be treated with specialized physical therapy known as biofeedback.
With biofeedback, a therapist helps to improve a person’s rectal sensation and pelvic floor muscle coordination.
There are various effective techniques used in biofeedback.
Some therapists train patients by teaching them to expel a small balloon placed in the rectum.
Another technique uses a small probe placed in the rectum or vagina or electrodes placed on the surface of the skin around the opening to the rectum (anus) and on the abdominal wall.
These instruments detect when a muscle is contracting or relaxing and provide visual feedback of the muscle action.
This visual feedback helps the individual to understand the muscle movement and aids in improving muscle coordination.
Approximately 75% of individuals with pelvic floor dysfunction experience significant improvement with biofeedback.
Abnormalities identified with a defecating proctogram such as rectal prolapse and rectocele may be treated with a surgical procedure.

Colonoscopy

Colonoscopy is a safe, effective method of examining the full lining of the colon and rectum, using a long, flexible, tubular instrument.
It is used to diagnose colon and rectum problems and to perform biopsies and remove colon polyps.
Most colonoscopies are done on an outpatient basis with minimal inconvenience and discomfort.

Who should have a colonoscopy?
Colonoscopy is routinely recommended to adults 50 years of age or older as part of a colorectal cancer screening program.
Patients with a family history of colon or rectal cancer may have their colonoscopy at age 40.
Your physician may also recommend a colonoscopy exam if you have change in bowel habit or bleeding, indicating a possible problem in the colon or rectum.
A colonoscopy may be necessary to:
- check unexplained abdominal symptoms
- check inflammatory bowel disease (colitis)
- verify findings of polyps or tumors located with a barium enema exam
- examine patients who test positive for blood in the stool
- monitor patients with a personal or family history of colon polyps or cancer

How is colonoscopy performed?
The bowel must first be thoroughly cleared of all residue before a colonoscopy.
This is done one to two days before the exam with a preparation prescribed by your physician.
Many patients receive intravenous sedation, or twilight sleep for this procedure.
The colonoscope is inserted into the rectum and is advanced to the portion of the colon where the small intestine joins the colon.
During a complete examination of the bowel, your physician will remove polyps or take biopsies as necessary.
The entire procedure usually takes less than an hour.
Following the colonoscopy, there may be slight discomfort, which quickly improves with the expelling of gas.
Most patients can resume their regular diet and activities the same day.

What are the benefits of colonoscopy?
Colonoscopy is more accurate than an x-ray exam of the colon to detect polyps or early cancer.
With colonoscopy, it is now possible to detect and remove most polyps without abdominal surgery.
Removing polyps is an important step in the prevention of colon cancer.

What are the risks of colonoscopy?
Colonoscopy is a very safe procedure with complications occurring in less than 1% of patients.
These risks include bleeding, a tear in the intestine, risks of anesthesia and failure to detect a polyp.

Colorectal cancer

Colorectal cancer is the second most common cancer in the United States, striking 140,000 people annually and causing 60,000 deaths.
That's a staggering figure when you consider the disease is potentially curable if diagnosed in the early stages.

Who is at risk?
Though colorectal cancer may occur at any age, more than 90% of the patients are over age 40, at which point the risk doubles every ten years.
In addition to age, other high risk factors include a family history of colorectal cancer and polyps and a personal history of ulcerative colitis, colon polyps or cancer of other organs, especially of the breast or uterus.

How does it start?
It is generally agreed that nearly all colon and rectal cancer begins in benign polyps.
These pre-malignant growths occur on the bowel wall and may eventually increase in size and become cancer.
Removal of benign polyps is one aspect of preventive medicine that really works.

What are the symptoms?
The most common symptoms are rectal bleeding and changes in bowel habits, such as constipation or diarrhea.
These symptoms are also common in other diseases so it is important you receive a thorough examination should you experience them.
Abdominal pain and weight loss are usually late symptoms indicating possible extensive disease.
Unfortunately, many polyps and early cancers fail to produce symptoms.
Therefore, it is important that your routine physical includes colorectal cancer detection procedures once you reach age 50.
There are several methods for detection of colorectal cancer.
These include digital rectal examination, a chemical test of the stool for blood, flexible sigmoidoscopy and colonoscopy (lighted tubular instruments used to inspect the lower bowel) and barium enema.
Be sure to discuss these options with your surgeon to determine which procedure is best for you.
Individuals who have a first-degree relative (parent or sibling) with colon cancer or polyps should start their colon cancer screening at the age of 40.

How is colorectal cancer treated?
Colorectal cancer requires surgery in nearly all cases for complete cure.
Radiation and chemotherapy are sometimes used in addition to surgery.
Between 80-90% are restored to normal health if the cancer is detected and treated in the earliest stages.
The cure rate drops to 50% or less when diagnosed in the later stages.
Thanks to modern technology, less than 5% of all colorectal cancer patients require a colostomy, the surgical construction of an artificial excretory opening from the colon.

Can colon cancer be prevented?
Colon cancer is preventable.
The most important step towards preventing colon cancer is getting a screening test.
Any abnormal screening test should be followed by a colonoscopy.
Some individuals prefer to start with colonoscopy as a screening test.
Colonoscopy provides a detailed examination of the bowel.
Polyps can be identified and can often be removed during colonoscopy.
Though not definitely proven, there is some evidence that diet may play a significant role in preventing colorectal cancer.
As far as we know, a high fiber, low fat diet is the only dietary measure that might help prevent colorectal cancer.
Finally, pay attention to changes in your bowel habits.
Any new changes such as persistent constipation, diarrhea, or blood in the stool should be discussed with your physician.

Can hemorrhoids lead to colon cancer?
No, but hemorrhoids may produce symptoms similar to colon polyps or cancer.
Should you experience these symptoms, you should have them examined and evaluated by a physician, preferably by a colon and rectal surgeon.

Anal cancer

Cancer describes a set of diseases in which normal cells in the body, through a series of genetic changes, become abnormal and lose the ability to control their growth.
As cancers – also known as malignancies – grow, they invade the tissues around them (local invasion).
They may also spread to other locations in the body via the blood vessels or lymphatic channels where they may implant and grow (metastases).
The anus or anal canal is the passage that connects the rectum, or last part of the large intestine, to the outside of the body.
Anal cancer arises from the cells around the anal opening or in the anal canal just inside the anal opening.
Anal cancer is often a type of cancer called squamous cell carcinoma.
Other rare types of cancer may also occur in the anal canal and these require consultation with your physician or surgeon to determine the appropriate evaluation and treatment.
Cells that are becoming malignant or premalignant, but have not invaded deeper into the skin, are referred to as high-grade anal intraepithelial neoplasia or HGAIN (previously referred to by a number of different terms, including high grade dysplasia, carcinoma-in-situ, anal intra-epithelial neoplasia grade III, high-grade squamous intraepithelial lesion, or Bowen's disease).
While this condition is likely a precursor to anal cancer, this is not anal cancer and is treated differently than anal cancer.
Your physician or colon and rectal surgeon can help clarify the differences.

How common is anal cancer?
Anal cancer is fairly uncommon, and accounts for about 1-2% of cancers affecting the intestinal tract.
Approximately one in 600 men and women will get anal cancer in their lifetime (this can be compared to 1 in 20 men and women who will developed colon and rectal cancer in their lifetime).
Almost 6,000 new cases of anal cancer are now diagnosed each year in the U.S., with about 2/3rds of the cases in women.
Approximately 800 people will die of the disease each year.
Unlike some cancers, the numbers of patients that develop anal cancer each year is slowly increasing, especially in some higher risk groups (see below).

Who is at risk?
A risk factor is something that increases a person's chance of getting a disease.
Anal cancer is commonly associated with infection with the human papilloma virus (HPV), but some anal cancers develop without this infection being present.
HPV can also cause warts in and around the anus as well as genital warts (on the penis in men and the vagina or cervix in women), but warts do not have to be present for anal cancer to develop.
HPV is also associated with an increased risk of cervical and vaginal or vulvar cancer in women, penile cancer in men, as well as with some head and neck cancers in men and women.
Having some of these cancers, especially cervical or vulvar cancer (or even pre-cancerous change in the cervix or vulva), can put people at increased risk for anal cancer – likely from the association with HPV infection.

Additional risk factors for anal cancer include:
- age (while most of the cases of anal cancer develop in people over age 55, 1/3rd of the cases occur in patients that are younger than that)
- anal sex (people participating in anal sex, both men and women, are at increased risk)
- sexually transmitted diseases (patients with multiple sex partners are at higher risk of getting sexually transmitted diseases like HPV and HIV and are, therefore, at an increased risk of developing anal cancer)
- smoking (harmful chemicals from smoking increases the risk of most cancers, including anal cancer)
- immunosuppression (people with weakened immune systems, such as transplant patients who must take drugs to suppress their immune systems and patients with HIV infection, are at higher risk)
- chronic local inflammation (people with long-standing anal fistulas or open wounds in the anal area are at a slightly higher risk)
- pelvic radiation (people who have had pelvic radiation therapy for rectal, prostate, bladder or cervical cancer are at increased risk)

Can anal cancer be prevented?
Few cancers can be totally prevented, but the risk of developing anal cancer may be decreased significantly by avoiding the risk factors listed above and by getting regular checkups.
Avoiding anal sex and infection with HPV and HIV can reduce the risk of developing anal cancer.
Using condoms whenever having any kind of intercourse may reduce, but not eliminate, the risk of HPV infection.
Smoking cessation lowers the risk of many types of cancer, including anal cancer.
Vaccines against infection with certain types of HPV, especially in high-risk patients (see risk factors listed above), may also decrease the risk of developing anal cancer (in men and women).
People who are at increased risk for anal cancer based on the risk factors listed above should talk to their doctors about consideration for anal cancer screening.
This can include anal cytology or Pap tests (much like the Pap tests women undergo for cervical cancer screening).
Early identification and treatment of premalignant lesions in the anus may also prevent the development of anal cancer.

What are the symptoms of anal cancer?
Although 20% of anal cancers may be asymptomatic, many cases of anal cancer can be found early because they form in a part of the digestive tract that a doctor can see and reach easily.

Anal cancers may cause symptoms such as:
- bleeding from the rectum or anus
- the feeling of a lump or mass at the anal opening
- persistent or recurring pain in the anal area
- persistent or recurrent itching
- change in bowel habits (having more or fewer bowel movements) or increased straining during a bowel movement
- narrowing of the stools
- discharge or drainage (mucous or pus) from the anus
- swollen lymph nodes (glands) in the anal or groin areas

These symptoms can also be caused by less serious conditions such as hemorrhoids, but you should never assume this.
If you have any of these symptoms, see your doctor or colon and rectal surgeon.

How is anal cancer diagnosed?
Anal cancer is usually found on examination of the anal canal because of the presence of symptoms listed above, on routine yearly physical exams by a physician (rectal exam for prostate check or at the time of a pelvic exam), or on screening tests such as those recommended for preventing or diagnosing colorectal cancer (for example: colonoscopy or lighted scope exam of the colon and rectum or yearly stool blood tests).
Anoscopy, or examination of the anal canal with a small, lighted scope, may be performed as well to assess any abnormal findings.
If an abnormal area in the anal canal is identified based on the doctor's exam, a biopsy will be performed to determine the diagnosis.
If the diagnosis of anal cancer is confirmed, additional tests to determine the extent of the cancer may be recommended, which may include ultrasounds, Xrays, CT scans, and/or PET scans.

How are anal cancers treated?
Treatment for most cases of anal cancer is very effective in curing the cancer.

Combination therapy including radiation therapy and chemotherapy is now considered the standard treatment for most anal cancers.
Occasionally, a very small or early tumor may be removed surgically (local excision) without the need for further treatment and with minimal damage to the anal sphincter muscles that are important for bowel control.
On occasion, more major surgery to remove the anal cancer is needed, and this requires the creation of a colostomy where the bowel is brought out to the skin on the belly wall where a bag is attached to collect the fecal matter.

Will I need a colostomy?
The majority of patients treated for anal cancer will not need a colostomy.
If the tumor does not respond completely to combination therapy, if it recurs after treatment, or if it is an unusual type of anal cancer, removal of the rectum and anus and creation of a permanent colostomy may be necessary.
This operation is known as an abdominoperineal resection (APR).

What happens after treatment for anal cancer?
Follow-up care to assess the results of treatment and to check for recurrence is very important.
Most anal cancers are cured with combination therapy and/or surgery, so you should report any symptoms or problems to your doctor or surgeon right away.
In addition, many tumors that recur may be successfully treated with surgery if they are caught early.
A careful examination by an experienced physician or colon and rectal surgeon at regular intervals is the most important method of follow-up.
Additional studies, such as certain types of scans (for example, CT or MRI) or ultrasounds, may also be recommended.

Conclusion
Anal cancers are unusual tumors arising from the skin or lining of the anal canal.
As with most cancers, early detection is associated with excellent survival.
Most tumors are well-treated with combination chemotherapy and radiation.
Recurrences, treatment failures, and advanced disease may require surgery.
Follow the recommended screening examinations for anal and colorectal cancer and consult your doctor or colon and rectal surgeon early when any concerning symptoms occur.

Anal warts

What are anal warts?
Anal warts (also called condyloma acuminata) are a condition that affects the area around and inside the anus.
They may also affect the skin of the genital area.
They first appear as tiny spots or growths, perhaps as small as the head of a pin, and may grow quite large and cover the entire anal area.
Usually, they do not cause pain or discomfort to afflicted individuals and patients may be unaware that the warts are present.
Some patients will experience symptoms, such as itching, bleeding, mucus discharge and/or a feeling of a lump or mass in the anal area.

What causes anal warts?
They are caused by the human papilloma virus (HPV), which is transmitted from person to person by direct contact.
HPV is considered a sexually transmitted disease (STD).
You do not have to have anal intercourse to develop anal warts.

Do anal warts always need to be removed?
Yes. If they are not removed, the warts usually grow larger and multiply.
Left untreated, the warts may lead to an increased risk of cancer in the affected area.

What treatments are available?
If warts are very small and are located only on the skin around the anus, they may be treated with a topical medication.
They may also be treated by freezing the warts with liquid nitrogen or removed surgically.
Surgery typically involves cutting or burning the warts off.
While this provides immediate results, it must be performed using either a local anesthetic - such as novocaine - or a general or spinal anesthetic, depending on the number and exact location of warts being treated.
It is important that an internal anal examination with an instrument called an anoscope be done by your treating physician to ensure you do not have any inside the anal canal (internal anal warts).
Internal anal warts may not be as suitable for treatment by topical medications, and may need to be treated surgically.
Additionally, your physician may wish to examine the entire pelvic region to include the vaginal or penile area to look for other warts that may require treatment.

Must I be hospitalized for surgical treatment?
Surgical treatment of anal warts is usually performed as outpatient surgery.

How much time will I lose from work after surgical treatment?
Most people are moderately uncomfortable for a few days after treatment and pain medication may be prescribed.
Depending on the extent of the disease, some people return to work the next day, while others may remain out of work for several days to weeks.

Will a single treatment cure the problem?
When warts are extensive, your surgeon may wish to perform the surgery in stages.
Additionally, recurrent warts are common.
The virus that causes the warts can live concealed in tissues that appear normal for several months before another wart develops.
As new warts develop, they usually can be treated in the physician's office.
Sometimes new warts develop so rapidly that office treatment would be quite uncomfortable.
In these situations, a second and, occasionally, third outpatient surgical visit may be recommended.

How long is treatment usually continued?
Follow-up visits are necessary at frequent intervals for several months after all warts appear to be gone, to be certain that no new warts occur.

What can be done to avoid getting these warts again?
In some cases, warts may recur repeatedly after successful removal, since the virus that causes the warts often persists in a dormant state in body tissues.
Discuss with your physician how often you should be evaluated for recurrent warts.
Abstain from sexual contact with individuals who have anal (or genital) warts.
Since many individuals may be unaware that they suffer from this condition, sexual abstinence, condom protection or limiting sexual contact to single partner will reduce your potential exposure to the contagious virus that causes these warts.
As a precaution, sexual partners ought to be checked for warts and other sexual transmitted diseases, even if they have no symptoms.

Diverticulosis - Diverticulitis

Diverticulosis of the colon is a common condition that afflicts about 50% of Americans by age 60 and nearly all by age 80.
Only a small percentage of those with diverticulosis have symptoms, and even fewer will ever require surgery.

What is diverticulosis and diverticulitis?
Diverticula are pockets that develop in the colon wall, usually in the sigmoid or left colon, but may involve the entire colon.
Diverticulosis describes the presence of these pockets.
Diverticulitis describes inflammation or complications of these pockets.

What are the symptoms of diverticular disease?
Uncomplicated diverticular disease is usually not associated with symptoms.
Symptoms are related to complications of diverticular disease including diverticulits and bleeding.
Diverticular disease is a common cause of significant bleeding from the colon.
Diverticulitis - an infection of the diverticula - may cause one or more of the following symptoms: pain in the abdomen, chills, fever and change in bowel habits.
More intense symptoms are associated with serious complications such as perforation (rupture), abscess or fistula formation (an abnormal connection between the colon and another organ or the skin).

What is the cause of diverticular disease?
The cause of diverticulosis and diverticulitis is not precisely known, but it is more common for people with a low fiber diet.
It is thought that a low-fiber diet over the years creates increased colon pressure and results in pockets or diverticula.

How is diverticular disease treated?
Increasing the amount of dietary fiber (grains, legumes, vegetables, etc.) - and sometimes restricting certain foods reduces the pressure in the colon and may decrease the risk of complications due to diverticular disease.
Diverticulitis requires different management.
Mild cases may be managed with oral antibiotics, dietary restrictions and possibly stool softeners.
More severe cases require hospitalization with intravenous antibiotics and dietary restraints.
Most acute attacks can be relieved with such methods.

When is surgery necessary?
Surgery is reserved for patients with recurrent episodes of diverticulitis, complications or severe attacks when there's little or no response to medication.
Surgery may also be required in individuals with a single episode of severe bleeding from diverticulosis or with recurrent episodes of bleeding.
Surgical treatment for diverticulitis removes the diseased part of the colon, most commonly, the left or sigmoid colon.
Often the colon is hooked up or anastomosed again to the rectum.
Complete recovery can be expected.
Normal bowel function usually resumes in about three weeks.
In emergency surgeries, patients may require a temporary colostomy bag.
Patients are encouraged to seek medical attention for abdominal symptoms early to help avoid complications.

Hemorrhoids

Hemorrhoids are one of the most common ailments known.
More than half the population will develop hemorrhoids, usually after age 30.
Millions of Americans currently suffer from hemorrhoids.
The average person suffers in silence for a long period before seeking medical care.
Today's treatment methods make some types of hemorrhoid removal much less painful.

Often described as varicose veins of the anus and rectum, hemorrhoids are enlarged, bulging blood vessels in and about the anus and lower rectum.
There are two types of hemorrhoids: external and internal, which refer to their location.
External (outside) hemorrhoids develop near the anus and are covered by very sensitive skin.
These are usually painless.
However, if a blood clot (thrombosis) develops in an external hemorrhoid, it becomes a painful, hard lump.
The external hemorrhoid may bleed if it ruptures.
Internal (inside) hemorrhoids develop within the anus beneath the lining.
Painless bleeding and protrusion during bowel movements are the most common symptom.
However, an internal hemorrhoid can cause severe pain if it is completely prolapsed - protrudes from the anal opening and cannot be pushed back inside.

What causes hemorrhoids?
An exact cause is unknown; however, the upright posture of humans alone forces a great deal of pressure on the rectal veins, which sometimes causes them to bulge.

Whatever the cause, the tissues supporting the vessels stretch.
As a result, the vessels dilate; their walls become thin and bleed.
If the stretching and pressure continue, the weakened vessels protrude.

What are the symptoms?
If you notice any of the following, you could have hemorrhoids:
- bleeding during bowel movements
- protrusion during bowel movements
- itching in the anal area
- pain
- sensitive lump(s)

How are hemorrhoids treated?
Mild symptoms can be relieved frequently by increasing the amount of fiber (e.g., fruits, vegetables, breads and cereals) and fluids in the diet.
Eliminating excessive straining reduces the pressure on hemorrhoids and helps prevent them from protruding.
A sitz bath - sitting in plain warm water for about 10 minutes - can also provide some relief.
With these measures, the pain and swelling of most symptomatic hemorrhoids will decrease in two to seven days, and the firm lump should recede within four to six weeks.
In cases of severe or persistent pain from a thrombosed hemorrhoid, your physician may elect to remove the hemorrhoid containing the clot with a small incision.
Performed under local anesthesia as an outpatient, this procedure generally provides relief.

Severe hemorrhoids may require special treatment, much of which can be performed on an outpatient basis.
- ligation – the rubber band treatment - works effectively on internal hemorrhoids that protrude with bowel movements.
A small rubber band is placed over the hemorrhoid, cutting off its blood supply.
The hemorrhoid and the band fall off in a few days and the wound usually heals in a week or two.
This procedure sometimes produces mild discomfort and bleeding and may need to be repeated for a full effect.

- injection and coagulation can also be used on bleeding hemorrhoids that do not protrude.
Both methods are relatively painless and cause the hemorrhoid to shrivel up.

- hemorrhoid stapling – this is a technique that uses a special device to internally staple and excise internal hemorrhoidal tissue.
The stapling method may lead to shrinkage of but does not remove external hemorrhoids.
This procedure is generally more painful that rubber band ligation and less painful than hemorroidectomy.

- hemorrhoidectomy – surgery to remove the hemorrhoids - is the most complete method for removal of internal and external hemorrhoids.
It is necessary when clots repeatedly form in external hemorrhoids; ligation fails to treat internal hemorrhoids; the protruding hemorrhoid cannot be reduced; or there is persistent bleeding.
A hemorrhoidectomy removes excessive tissue that causes the bleeding and protrusion.
It is done under anesthesia using either sutures or staplers, and may, depending upon circumstances, require hospitalization and a period of inactivity.
Laser hemorrhoidectomies do not offer any advantage over standard operative techniques.
They are also quite expensive, and contrary to popular belief, are no less painful.

Do hemorrhoids lead to cancer?
No. There is no relationship between hemorrhoids and cancer.
However, the symptoms of hemorrhoids, particularly bleeding, are similar to those of colorectal cancer and other diseases of the digestive system.
Therefore, it is important that all symptoms are investigated by a physician specially trained in treating diseases of the colon and rectum and that everyone 50 years or older undergo screening tests for colorectal cancer.
Do not rely on over-the-counter medications or other self-treatments.
See a colorectal surgeon first so your symptoms can be properly evaluated and effective treatment prescribed.

Anal abscess fistula

An anal abscess is an infected cavity filled with pus found near the anus or rectum.

What is an anal fistula?
An anal fistula (also called fistula-in-ano) is frequently the result of a previous or current anal abscess, occurring in up to 50% of patients with abscesses.
Normal anatomy includes small glands just inside the anus.
Occasionally, these glands get clogged and potentially can become infected, leading to an abscess.
The fistula is a tunnel that forms under the skin and connects the infected glands to the abscess.
A fistula can be present with or without an abscess and may connect just to the skin of the buttocks near the anal opening.
Other situations that can result in a fistula include Crohn's disease, radiation, trauma and malignancy.

How does someone get an anal abscess or a fistula?
The abscess is most often a result of an acute infection in the internal glands of the anus.
Occasionally, bacteria, fecal material or foreign matter can clog the anal gland and create a condition for an abscess cavity to form.
Other medical conditions can make these types of infections more likely.
After an abscess drains on its own or has been drained (opened), a tunnel (fistula) may persist, connecting the infected anal gland to the external skin.
This typically will involve some type of drainage from the external opening and occurs in up to 50% of abscesses.
If the opening on the skin heals when a fistula is present, a recurrent abscess may develop.

What are the specific signs or symptoms of an abscess or fistula?
A patient with an abscess may have pain, redness or swelling in the area around the anal area.
Fatigue, general malaise, as well as accompanying fever or chills are also common.
Similar signs and symptoms may be present when patients have a fistula, with the addition of possible irritation of the perianal skin or drainage from an external opening.

Is any specific testing necessary to diagnose an abscess or fistula?
No. Most anal abscesses or fistula-in-ano are diagnosed and managed on the basis of clinical findings.
Occasionally, additional studies such as ultrasound, CT scan, or MRI can assist with the diagnosis of deeper abscesses or the delineation of the fistula tunnel to help guide treatment.

What is the treatment of an anal abscess?
The treatment of an abscess is surgical drainage under most circumstances.
An incision is made in the skin near the anus to drain the infection.
This can be done in a doctor's office with local anesthetic or in an operating room under deeper anesthesia.
Hospitalization may be required for patients prone to more significant infections such as diabetics or patients with decreased immunity.

Are antibiotics required to treat this type of infection?
Antibiotics alone are a poor alternative to drainage of the infection.
For uncomplicated abscesses, the addition of antibiotics to surgical drainage does not improve healing time or reduce the potential for recurrences.
There are some conditions in which antibiotics are indicated, such as for patients with compromised or altered immunity, some cardiac valvular conditions or extensive cellulitis.
A comprehensive discussion of your past medical history and a physical exam are important to determine if antibiotics are indicated.

What is the treatment of an anal fistula?
Surgery is almost always necessary to cure an anal fistula.
Although surgery can be fairly straightforward, it may also be complicated, occasionally requiring staged or multiple operations.
Consider identifying a specialist in colon and rectal surgery who would be familiar with a number of potential operations to treat the fistula.
The surgery may be performed at the same time as drainage of an abscess, although sometimes the fistula doesn't appear until weeks to years after the initial drainage.
If the fistula is straightforward, a fistulotomy may be performed.
This procedure involves connecting the internal opening within the anal canal to the external opening, creating a groove that will heal from the inside out.
This surgery often will require dividing a small portion of the sphincter muscle which has the unlikely potential for affecting the control of bowel movements in a limited number of cases.
Other procedures include placing material within the fistula tract to occlude it or surgically altering the surrounding tissue to accomplish closure of the fistula, with the choice of procedure depending upon the type, length, and location of the fistula.
Most of the operations can be performed on an outpatient basis, but may occasionally require hospitalization.

What is the recovery like from surgery?
Pain after surgery is controlled with pain pills, fiber and bulk laxatives.
Patients should plan for time at home using sitz baths and attempt to avoid the constipation that can be associated with prescription pain medication.
Discuss with your surgeon the specific care and time away from work prior to surgery to prepare yourself for post-operative care.

Can the abscess or fistula recur?
If adequately treated and properly healed, both are unlikely to return.
However, despite proper and indicated open or minimally invasive treatment, both abscesses and fistulas can potentially recur.
Should similar symptoms arise, suggesting recurrence, it is recommended that you find a colon and rectal surgeon to manage your condition.

Bowel incontinence

Incontinence is the impaired ability to control gas or stool.
Its severity ranges from mild difficulty with gas control to severe loss of control over liquid and formed stools.
Incontinence to stool is a common problem, but often it is not discussed due to embarassment.

What causes incontinence?
There are many causes of incontinence.
Injury during childbirth is one of the most common causes.
These injuries may cause a tear in the anal muscles.
The nerves supplying the anal muscles may also be injured.
While some injuries may be recognized immediately following childbirth, many others may go unnoticed and not become a problem until later in life.
In these situations, a prior childbirth may not be recognized as the cause of incontinence.
Anal operations or traumatic injury to the tissue surrounding the anal region similarly can damage the anal muscles and hinder bowel control.
Some individuals experience loss of strength in the anal muscles as they age.
As a result, a minor control problem in a younger person may become more significant later in life.
Diarrhea may be associated with a feeling of urgency or stool leakage due to the frequent liquid stools passing through the anal opening.
If bleeding accompanies lack of bowel control, consult your physician.
These symptoms may indicate inflammation within the colon (colitis), a rectal tumor, or rectal prolapse - all conditions that require prompt evaluation by a physician.

How is the cause of incontinence determined?
An initial discussion of the problem with your physician will help establish the degree of control difficulty and its impact on your lifestyle.
Many clues to the origin of incontinence may be found in patient histories.
For example, a woman's history of past childbirths is very important.
Multiple pregnancies, large weight babies, forceps deliveries, or episiotomies may contribute to muscle or nerve injury at the time of childbirth.
In some cases, medical illnesses and medications play a role in problems with control.
A physical exam of the anal region should be performed.
It may readily identify an obvious injury to the anal muscles.
In addition, an ultrasound probe can be used within the anal area to provide a picture of the muscles and show areas in which the anal muscles have been injured.
Frequently, additional studies are required to define the anal area more completely.
In a test called anal manometry, a small catheter is placed into the anus to record pressure as patients relax and tighten the anal muscles.
This test can demonstrate how weak or strong the muscle really is.
A separate test may also be conducted to determine if the nerves that go to the anal muscles are functioning properly.

After a careful history, physical examination and testing to determine the cause and severity of the problem, treatment can be addressed.
Mild problems may be treated very simply with dietary changes and the use of some constipating medications.
Diseases which cause inflammation in the rectum, such as colitis, may contribute to anal control problems.
Treating these diseases also may eliminate or improve symptoms of incontinence.
Sometimes a change in prescribed medications may help.
Your physician also may recommend simple home exercises that may strengthen the anal muscles to help in mild cases.
A type of physical therapy called biofeedback can be used to help patients sense when stool is ready to be evacuated and help strengthen the muscles.
Injuries to the anal muscles may be repaired with surgery.
Some individuals may benefit from a technique that delivers electrical energy to the skin and muscles surrounding the anus which results in firming and thickening of this area to help with continence.
In certain individuals that have nerve damage or anal muscles that are damaged beyond repair, an artificial sphincter may be implanted.
The artificial sphincter is a plastic, fluid filled doughnut that is surgically implanted around the damaged anal sphincter.
This artificial sphincter keeps the anal canal closed.
When an individual wants to have a bowel movement, the fluid can be pumped out of the doughnut to allow the anal canal to open.
In extreme cases, patients may find that a colostomy is the best option for improving their quality of life.

Pilonidal disease

What is pilonidal disease and what causes it?
Pilonidal disease is a chronic infection of the skin in the region of the buttock crease.
The condition results from a reaction to hairs embedded in the skin, commonly occurring in the cleft between the buttocks.
The disease is more common in men than women and frequently occurs between puberty and age 40.
It is also common in obese people and those with thick, stiff body hair.

What are the symptoms?
Symptoms vary from a small dimple to a large painful mass.
Often the area will drain fluid that may be clear, cloudy or bloody.
With infection, the area becomes red, tender, and the drainage (pus) will have a foul odor.
The infection may also cause fever, malaise, or nausea.
There are several common patterns of this disease.
Nearly all patients have an episode of an acute abscess (the area is swollen, tender, and may drain pus).
After the abscess resolves, either by itself or with medical assistance, many patients develop a pilonidal sinus.
The sinus is a cavity below the skin surface that connects to the surface with one or more small openings or tracts.
Although a few of these sinus tracts may resolve without therapy, most patients need a small operation to eliminate them.
A small number of patients develop recurrent infections and inflammation of these sinus tracts.
The chronic disease causes episodes of swelling, pain, and drainage.
Surgery is almost always required to resolve this condition.

How is pilonidal disease treated?
The treatment depends on the disease pattern.
An acute abscess is managed with an incision and drained to release the pus, and reduce the inflammation and pain.
This procedure usually can be performed in the office with local anesthesia.
A chronic sinus usually will need to be excised or surgically opened.
Complex or recurrent disease must be treated surgically.
Procedures vary from unroofing the sinuses to excision and possible closure with flaps.
Larger operations require longer healing times.
If the wound is left open, it will require dressing or packing to keep it clean.
Although it may take several weeks to heal, the success rate with open wounds is higher.
Closure with flaps is a bigger operation that has a higher chance of infection; however, it may be required in some patients.
Your surgeon will discuss these options with you and help you select the appropriate operation.

What care is required after surgery?
If the wound can be closed, it will need to be kept clean and dry until the skin is completely healed.
If the wound must be left open, dressings or packing will be needed to help remove secretions and to allow the wound to heal from the bottom up.
After healing, the skin in the buttocks crease must be kept clean and free of hair.
This is accomplished by shaving or using a hair removal agent every two or three weeks until age 30.
After age 30, the hair shaft thins, becomes softer and the buttock cleft becomes less deep.

Crohn's disease

Crohn's disease is a chronic inflammatory process primarily involving the intestinal tract.
Although it may involve any part of the digestive tract from the mouth to the anus, it most commonly affects the last part of the small intestine (ileum) and/or the large intestine (colon and rectum).
Crohn's disease is a chronic condition and may recur at various times over a lifetime.
Some people have long periods of remission, sometimes for years, when they are free of symptoms.
There is no way to predict when a remission may occur or when symptoms will return.

What are the symptoms of Crohn's disease?
Because Crohn's disease can affect any part of the intestine, symptoms may vary greatly from patient to patient.
Common symptoms include cramping, abdominal pain, diarrhea, fever, weight loss, and bloating.
Not all patients experience all of these symptoms, and some may experience none of them.
Other symptoms may include anal pain or drainage, skin lesions, rectal abscess, fissure, and joint pain (arthritis).

Who does it affect?
Any age group may be affected, but the majority of patients are young adults between 16 and 40 years old.
Crohn's disease occurs most commonly in people living in northern climates.
It affects men and women equally and appears to be common in some families.
About 20% of people with Crohn's disease have a relative, most often a brother or sister, and sometimes a parent or child, with some form of inflammatory bowel disease.
Crohn's disease and a similar condition called ulcerative colitis are often grouped together as inflammatory bowel disease.
The two diseases afflict an estimated two million individuals in the U.S.

What causes Crohn's disease?
The exact cause is not known.
However, current theories center on an immunologic (the body's defense system) and/or bacterial cause.
Crohn's disease is not contagious, but it does have a slight genetic (inherited) tendency.
An x-ray study of the small intestine may be used to diagnose Crohn's disease.

How is Crohn's disease treated?
Initial treatment is almost always with medication.
There is no cure for Crohn's disease, but medical therapy with one or more drugs provides a means to treat early Crohn's disease and relieve its symptoms.
The most common drugs prescribed are corticosteroids, such as prednisone and methylprednisolone, and various anti-inflammatory agents.
Other drugs occasionally used include 6-mercaptopurine and azathioprine, which are immunosuppressive.
Metronidazole, an antibiotic with immune system effects, is frequently helpful in patients with anal disease.
In more advanced or complicated cases of Crohn's disease, surgery may be recommended.
Emergency surgery is sometimes necessary when complications, such as a perforation of the intestine, obstruction (blockage) of the bowel, or significant bleeding occur with Crohn's disease.
Other less urgent indications for surgery may include abscess formation, fistulas (abnormal communications from the intestine), severe anal disease or persistence of the disease despite appropriate drug treatment.
Not all patients with these or other complications require surgery.
This decision is best reached through consultation with your gastroenterologist and your colon and rectal surgeon.

Shouldn't surgery for Crohn's disease be avoided at all costs?
While it is true that medical treatment is preferred as the initial form of therapy, it is important to realize that surgery is eventually required in up to three-fourths of all patients with Crohn's.
Many patients have suffered unnecessarily due to a mistaken belief that surgery for Crohn's disease is dangerous or that it inevitably leads to complications.
Surgery is not curative, although many patients never require additional operations.
A conservative approach is frequently taken, with a limited resection of intestine (removal of the diseased portion of the bowel) being the most common procedure.
Surgery often provides effective long-term relief of symptoms and frequently limits or eliminates the need for ongoing use of prescribed medications.
Surgical therapy is best conducted by a physician skilled and experienced in the management of Crohn's disease.

Polyps colon and rectum

Polyps are abnormal growths rising from the lining of the large intestine (colon or rectum) and protruding into the intestinal canal (lumen).
Some polyps are flat; others have a stalk.
Polyps are one of the most common conditions affecting the colon and rectum, occurring in 15 to 20% of the adult population.
Although most polyps are benign, the relationship of certain polyps to cancer is well established.
Polyps can occur throughout the large intestine or rectum, but are more commonly found in the left colon, sigmoid colon, or rectum.

What are the symptoms of polyps?
Most polyps produce no symptoms and often are found incidentally during endoscopy or x-ray of the bowel.
Some polyps, however, can produce bleeding, mucous discharge, alteration in bowel function, or in rare cases, abdominal pain.

How are polyps diagnosed?
Polyps are diagnosed either by looking at the colon lining directly (colonoscopy) or by x-ray study (barium enema).
There are three types of colorectal endoscopy: rigid sigmoidoscopy, flexible sigmoidoscopy and colonoscopy.
Rigid sigmoidoscopy permits examination of the lower six to eight inches of the large intestine.
In flexible sigmoidoscopy, the lower one-fourth to one-third of the colon is examined.
Neither rigid nor flexible sigmoidoscopy requires medication and can be performed in the doctor's office.
Colonoscopy uses a longer flexible instrument and usually permits inspection of the entire colon.
Bowel preparation is required, and sedation is often used.
The colon can also be indirectly examined using the barium enema x-ray technique.
This examination uses a barium solution to coat the colon lining.
X-rays are taken, and unsuspected polyps are frequently found.
Although checking the stool for microscopic blood is an important test for colon and rectal disorders, a negative test does not rule out the presence of polyps.
The discovery of one polyp necessitates a complete colon inspection, since at least 30% of these patients will have additional polyps.

Do polyps need to be treated?
Since there is no fool-proof way of predicting whether or not a polyp is or will become malignant, total removal of all polyps is advised.
The vast majority of polyps can be removed by snaring them with a wire loop passed through the instrument.
Small polyps can be destroyed simply by touching them with a coagulating electrical current.
Most colon examinations using the flexible colonoscope, including polyp removal, can be performed on an outpatient basis with minimal discomfort.
Large polyps may require more than one treatment for complete removal.
Some polyps cannot be removed by instruments because of their size or position; surgery is then required.

Can polyps recur?
Once a polyp is completely removed, its recurrence is very unusual.
However, the same factors that caused the polyp to form are still present.
New polyps will develop in at least 30% of people who have previously had polyps.
Patients should have regular exams by a physician specially trained to treat diseases of the colon and rectum.

Rectal prolapse

Rectal prolapse is a condition in which the rectum (the lower end of the colon, located just above the anus) becomes stretched out and protrudes out of the anus.
Weakness of the anal sphincter muscle is often associated with rectal prolapse at this stage, resulting in leakage of stool or mucus.
While the condition occurs in both sexes, it is much more common in women than men.

Why does it occur?
Several factors may contribute to the development of rectal prolapse.
It may come from a lifelong habit of straining to have bowel movements or as a late consequence of the childbirth process.
Rarely, there may be a genetic predisposition.
It seems to be a part of the aging process in many patients who experience stretching of the ligaments that support the rectum inside the pelvis as well as weakening of the anal sphincter muscle.
Sometimes rectal prolapse results from generalized pelvic floor dysfunction, in association with urinary incontinence and pelvic organ prolapse as well.
Neurological problems, such as spinal cord transection or spinal cord disease, can also lead to prolapse.
In most cases, however, no single cause is identified.

Is rectal prolapse the same as hemorrhoids?
Some of the symptoms may be the same: bleeding and/or tissue that protrudes from the rectum.
Rectal prolapse, however, involves a segment of the bowel located higher up within the body, while hemorrhoids develop near the anal opening.

How is rectal prolapse diagnosed?
A physician can often diagnose this condition with a careful history and a complete anorectal examination.
To demonstrate the prolapse, patients may be asked to sit on a commode and strain as if having a bowel movement.
Occasionally, a rectal prolapse may be hidden or internal, making the diagnosis more difficult.
In this situation, an x-ray examination called a videodefecogram may be helpful.
This examination, which takes x-ray pictures while the patient is having a bowel movement, can also assist the physician in determining whether surgery may be beneficial and which operation may be appropriate.
Anorectal manometry may also be used to evaluate the function of the muscles around the rectum as they relate to having a bowel movement.

How is rectal prolapse treated?
Although constipation and straining may contribute to the development of rectal prolapse, simply correcting these problems may not improve the prolapse once it has developed.
There are many different ways to surgically correct rectal prolapse.
Abdominal or rectal surgery may be suggested. An abdominal repair may be approached laparoscopically in selected patients.
The decision to recommend an abdominal or rectal surgery takes into account many factors, including age, physical condition, extent of prolapse and the results of various tests.

How successful is treatment?
A great majority of patients are completely relieved of symptoms, or are significantly helped, by the appropriate procedure.
Success depends on many factors, including the status of a patient's anal sphincter muscle before surgery, whether the prolapse is internal or external, the overall condition of the patient.
If the anal sphincter muscles have been weakened, either because of the rectal prolapse or for some other reason, they have the potential to regain strength after the rectal prolapse has been corrected.
It may take up to a year to determine the ultimate impact of the surgery on bowel function.
Chronic constipation and straining after surgical correction should be avoided.

Pruritus ani

Itching around the anal area is called pruritus ani.
This condition results in a compelling urge to scratch.

What causes this to happen?
Several factors may be at fault.
A common cause is excessive moisture in the anal area.
Moisture may be due to perspiration or a small amount of residual stool around the anal area.
Pruritis ani may be a symptom of other common anal conditions such as hemorrhoids and anal fissures.
The initial condition can be made worse by scratching, vigorous cleansing of the area or overuse of topical treatments.
In some individuals pruritus ani may be caused by eating certain foods, smoking and drinking alcoholic beverages, especially beer and wine.

Does Pruritus Ani result from lack of cleanliness?
Cleanliness is almost never a factor.
However, the natural tendency once a person develops this itching is to wash the area vigorously and frequently with soap and a washcloth.
This almost always makes the problem worse by damaging the skin and washing away protective natural oils.

What can be done to make this itching go away?
A careful examination by a colon and rectal surgeon or other physician may identify a definite cause for the itching.
Your physician can recommend treatment to eliminate the specific problem.
Treatment of pruritus ani may include these three points.

Avoid moisture in the anal area:
- apply either a few wisps of cotton, a 4x4 gauze or some cornstarch powder to keep the area dry
- avoid all medicated, perfumed and deodorant powders

Avoid further trauma to the affected area:
- do not use soap of any kind on the anal area
- do not scrub the anal area with anything – even toilet paper
- for hygiene, it is best to rinse with warm water and pat the area dry; use wet toilet paper, baby wipes or a wet washcloth to blot the area clean - never rub
- try not to scratch the itchy area; scratching produces more damage, which in turn makes the itching worse - for individuals that experience irresistible itching at night, wearing socks on the hands may be helpful.

Use only medications as directed by your physician.
Apply prescription medications sparingly to the skin around the anal area and avoid rubbing.
Prolonged use of prescribed or over the counter topical medications may result in irritation or skin dryness that can make the condition worse.

How long does this treatment usually take?
Most people experience some relief from itching within a week.
If symptoms do not resolve after 6 weeks, a follow-up appointment with your colon and rectal surgeon may be needed.

Anal fissure

An anal fissure (fissure-in-ano) is a small, oval shaped tear in skin that lines the opening of the anus.
Fissures typically cause severe pain and bleeding with bowel movements.
Fissures are quite common in the general population, but are often confused with other causes of pain and bleeding, such as hemorrhoids.

What are the symptoms of an anal fissure?
The typical symptoms of an anal fissure include severe pain during, and especially after, a bowel movement, lasting from several minutes to a few hours.
Patients may also notice bright red blood from the anus that can be seen on the toilet paper or on the stool.
Between bowel movements, patients with anal fissures are often relatively symptom-free.
Many patients are fearful of having a bowel movement and may try to avoid defecation secondary to the pain.

What causes an anal fissure?
Fissures are usually caused by trauma to the inner lining of the anus.
Patients with tight anal sphincter muscles (i.e., increased muscle tone) are more prone to developing anal fissures.
A hard, dry bowel movement is typically responsible, but loose stools and diarrhea can also be the cause.
Following a bowel movement, severe anal pain can produce spasm of the anal sphincter muscle, resulting in a decrease in blood flow to the site of the injury, thus impairing healing of the wound.
The next bowel movement results in more pain, anal spasm, decreased blood flow to the area, and the cycle continues.
Treatments are aimed at interrupting this cycle by relaxing the anal sphincter muscle to promote healing of the fissure.
Other, less common, causes include inflammatory conditions and certain anal infections or tumors.
Anal fissures may be acute (recent onset) or chronic (present for a long period of time).
Chronic fissures may be more difficult to treat, and may also have an external lump associated with the tear, called a sentinel pile or skin tag, as well as extra tissue just inside the anal canal (hypertrophied papilla).

What is the treatment of anal fissures?
The majority of anal fissures do not require surgery.
The most common treatment for an acute anal fissure consists of making the stool more formed and bulky with a diet high in fiber and utilization of over-the-counter fiber supplementation (totaling 25-35 grams of fiber/day).
Stool softeners and increasing water intake may be necessary to promote soft bowel movements and aid in the healing process.
Topical anesthetics for pain and warm tub baths (sitz baths) for 10-20 minutes several times a day (especially after bowel movements) are soothing and promote relaxation of the anal muscles, which may help the healing process.
Other medications (such as nitroglycerin, nifedipine, or diltiazem) may be prescribed that allow relaxation of the anal sphincter muscles.
Your surgeon will go over benefits and side-effects of each of these with you.
Narcotic pain medications are not recommended for anal fissures, as they promote constipation.
Chronic fissures are generally more difficult to treat, and your surgeon may advise surgical treatment.

Will the problem return?
Fissures can recur easily, and it is quite common for a fully healed fissure to recur after a hard bowel movement or other trauma.
Even when the pain and bleeding have subsided, it is very important to continue good bowel habits and a diet high in fiber as a lifestyle change.
If the problem returns without an obvious cause, further assessment is warranted.

What can be done if the fissure does not heal?
A fissure that fails to respond to conservative measures should be re-examined.
Persistent hard or loose bowel movements, scarring, or spasm of the internal anal muscle all contribute to delayed healing.
Other medical problems such as inflammatory bowel disease (Crohn's disease), infections, or anal tumors can cause symptoms similar to anal fissures.
Patients suffering from persistent anal pain should be examined to exclude these symptoms.
This may include a colonoscopy or an exam in the operating room under anesthesia.

What does surgery involve?
Surgical options for treating anal fissure include Botulinum toxin (Botox) injection into the anal sphincter and surgical division of a portion of the internal anal sphincter (lateral internal sphincterotomy).
Both of these are performed typically as outpatient, same-day procedures, or occasionally in the office setting.
The goal of these surgical options is to promote relaxation of the anal sphincter, thereby decreasing anal pain and spasm, allowing the fissure to heal.
Botox injection results in healing in 50-80% of patients, while sphincterotomy is reported to be over 90% successful.
If a sentinel pile is present, it may be removed to promote healing of the fissure.
All surgical procedures carry some risk, and a sphincterotomy can rarely interfere with one's ability to control gas and stool.
Your colon and rectal surgeon will discuss these risks with you to determine the appropriate treatment for your particular situation.

How long is the recovery after surgery?
It is important to note that complete healing with both medical and surgical treatments can take up to approximately 6-10 weeks.
However, acute pain after surgery often disappears after a few days.
Most patients will be able to return to work and resume daily activities in a few short days after the surgery.

Can fissures lead to colon cancer?
Absolutely not.
Persistent symptoms, however, need careful evaluation since other conditions other than an anal fissure can cause similar symptoms.
Your colon and rectal surgeon may request additional tests, even if your fissure has successfully healed.
A colonoscopy may be required to exclude other causes of rectal bleeding.

Rectocele

A rectocele is a bulging of the front wall of the rectum into the back wall of the vagina.
Rectoceles are usually due to thinning of the rectovaginal septum (the tissue between the rectum and vagina) and weakening of the pelvic floor muscles.
This is a very common defect; however, most women do not have symptoms.
There can also be other pelvic organs that bulge into the vagina, leading to similar symptoms as rectocele, including the bladder (i.e., cystocele) and the small intestines (i.e. enterocele).

What can lead to developing a rectocele?
There are many things that can lead to weakening of the pelvic floor, resulting in a rectocele.
These factors include: vaginal deliveries, birthing trauma during vaginal delivery (e.g. forceps delivery, vacuum delivery, tearing with a vaginal delivery, episiotomy during vaginal delivery), history of constipation, history of straining with bowel movements, and history of gynecological (hysterectomy) or rectal surgeries.

What are the symptoms associated with a rectocele?
Most people with a small rectocele do not have symptoms and it is often only discovered during routine physical examination.
When the rectocele is large, it most commonly presents with a noticeable bulge into the vagina.
Other rectal symptoms may include: difficulty with evacuation during a bowel movement, the need to press against the vagina and/or space between the rectum and the vagina in order to have a bowel movement, straining with bowel movements, constipation, the urge to have multiple bowel movements throughout the day, and rectal pain.
Occasionally, the stool becomes stuck in the bulge of the rectum, which is why it is difficult to have a bowel movement.
Vaginal symptoms can include: pain with sexual intercourse (dyspareunia), vaginal bleeding, and a sense of fullness in the vagina.

How can a rectocele be diagnosed?
A rectocele is usually found incidentally during a physical examination by your doctor.
The evaluation of its severity, and potential relation to constipation symptoms, is hard to assess with physical examination alone.
Further testing for a rectocele may include the use of a special x-ray study known as defecography (contrast material instilled into the rectum as an enema, followed by live x-ray imaging during a bowel movement).
This study is very specific and can evaluate a rectocele's size and ability to completely empty.

How can a rectocele be treated?
Rectoceles are not treated merely for their presence, but should only be addressed when they are associated with significant symptoms that interfere with quality of life.
Prior to any treatment, there should be a thorough evaluation by your doctor to assess whether all of the complaints can be attributed to the presence of a rectocele alone.
There are both medical and surgical treatment options for rectoceles.
The majority of symptoms associated with a rectocele can be resolved with medical management; however, treatment depends on the severity of symptoms.

How can a rectocele be treated with medical management only?
It is very important to have a good bowel regimen in order to avoid constipation and straining with bowel movements.
A high fiber diet, consisting of 25-30 grams of fiber daily, will help with this goal.
This may be achieved with a fiber supplement, high fiber cereal, or high fiber bars.
In addition to augmenting fiber intake, increased water intake (typically 6-8 glasses daily) is also highly recommended.
This will allow for softer stools that do not require significant straining with bowel movements, thereby reducing your risk for having a bulge associated with a rectocele.
Other treatments may include pelvic floor exercises such as Kegel exercises (i.e. biofeedback), stool softeners, hormone replacement therapy, and avoidance of straining with bowel movements.
At times, it is also helpful to apply pressure to the back of the vagina during bowel movements.

How can a rectocele be treated with surgical management?
The surgical management of rectoceles should only be considered when symptoms continue despite the use of medical management and are significant enough that they interfere with activities of daily living.
There are abdominal, rectal, and vaginal surgeries that can be performed for rectoceles.
The choice of procedure depends on the size of the rectocele and its associated symptoms.
Most surgeries aim to remove the extra tissue that makes up the rectocele and strengthening the wall between the rectum and vagina with surrounding tissue or use of a mesh (i.e. patch).
Colorectal surgeons, as well as gynecologists, are trained in the diagnosis and treatment of this condition.
The success rate of the surgery depends upon the specific symptoms and symptom duration.
Some of the risks of surgical correction of the rectocele are bleeding, infection, pain during intercourse (dyspareunia), as well as a risk that the rectocele may recur or worsen.

Ulcerative colitis

Ulcerative colitis is an inflammation of the lining of the large bowel (colon and rectum).
Symptoms include rectal bleeding, diarrhea, abdominal cramps, weight loss, and fevers.
In addition, patients who have had extensive ulcerative colitis for many years are at an increased risk to develop large bowel cancer.
The cause of ulcerative colitis remains unknown.

How is ulcerative colitis treated?
Initial treatment of ulcerative colitis is medical, using antibiotics and anti-inflammatory medications such as aminosalicylates.
If these fail, prednisone can be used for a short period of time but long-term use can be associated with significant side effects.
If prednisone is ineffective or cannot be discontinued, immunomodulators such as 6-mercaptopurine or azathioprine can be used to control active disease that does not merit hospitalization.
In order to maintain control of the disease, aminosalicylates or immunomodulators are used on a long-term basis.
Flare-ups of the disease can often be treated by increasing the dosage of medications or adding new medications.
Hospitalization may be necessary to put the bowel to rest and deliver steriods directly into the blood stream.

When is surgery necessary?
Surgery is indicated for patients who have life-threatening complications of inflammatory bowel diseases, such as massive bleeding, perforation, or infection.
It may also be necessary for those who have the chronic form of the disease, which fails to improve with medical therapy.
It is important the patient be comfortable that all reasonable medical therapy has been attempted prior to considering surgical therapy.
In addition, patients who have long-standing ulcerative colitis may be candidates for removal of the large bowel, because of the increased risk of developing cancer.
More often, these patients are followed carefully with repeated colonoscopy and biopsy, and surgery is recommended only if precancerous signs are identified.

What operations are available?
Historically, the standard operation for ulcerative colitis has been removal of the entire colon, rectum, and anus.
This operation is called a proctocolectomy and may be performed in one or more stages.
It eliminates the disease and removes all risk of developing cancer in the colon or rectum.
However, this operation requires creation of a Brooke ileostomy (bringing the end of the remaining bowel through the abdomen wall) and long-term use of an appliance on the abdominal wall to collect waste from the bowel.
The continent ileostomy is similar to a Brooke ileostomy, but an internal reservoir is created.
The bowel still comes through the abdominal wall, but an external appliance is not required.
Instead, the internal reservoir is drained three to four times a day by inserting a tube into the reservoir.
This option eliminates the risks of cancer and risks of recurrent persistent colitis, but the internal reservoir may begin to leak and require another surgical procedure to revise the reservoir.
Some patients may be treated by removal of the colon, with preservation of the rectum and anus.
The small bowel can then be reconnected to the rectum and continence preserved.
This avoids an ileostomy, but the risks of ongoing active colitis, increased stool frequency, urgency, and cancer in the retained rectum remain.

Are there other surgical alternatives?
The ileoanal procedure is the most common surgical treatment for the management of ulcerative colitis.
This procedure removes all of the colon and rectum, but preserves the anal canal.
The rectum is replaced with small bowel, which is refashioned to form a small pouch.
Usually, a temporary ileostomy is created, but this is closed several months later.
The pouch acts as a reservoir to help decrease the stool frequency.
This maintains a normal route of defecation, but most patients experience five to ten bowel movements per day.
This operation all but eliminates the risk of recurrent ulcerative colitis and allows the patient to have a normal route of evacuation.
Patients can develop inflammation of the pouch (pouchitis), which usually responds to antibiotic treatment.
In a small percentage of patients, the pouch fails to function properly and may have to be removed.
If the pouch is removed, a permanent ileostomy will likely be necessary.

Which alternative is preferred?
It is important to recognize that none of these alternatives makes a patient with ulcerative colitis normal.
Each alternative has perceivable advantages and disadvantages, which must be carefully understood by the patient prior to selecting the alternative which will allow the patient to pursue the highest quality of life.

Ostomy

An ostomy is a surgically created opening connecting an internal organ to the surface of the body.
Different kinds of ostomies are named for the organ involved.
The most common types of ostomies in intestinal surgery are an ileostomy (connecting the ileal part of the small intestine to the abdominal wall) and a colostomy (connecting the colon, or, large intestine to the abdominal wall).
An ostomy may be temporary or permanent.
A temporary ostomy may be required if the intestinal tract can't be properly prepared for surgery because of blockage by disease or scar tissue.
A temporary ostomy may also be created to allow inflammation or an operative site to heal without contamination by stool.
Temporary ostomies can usually be reversed with minimal or no loss of intestinal function.
A permanent ostomy may be required when disease, or its treatment, impairs normal intestinal function, or when the muscles that control elimination do not work properly or require removal.
The most common causes of these conditions are low rectal cancer and inflammatory bowel disease.
An ostomy connects either the small or the large intestine to the surface of the body.

How will I control my bowel movements?
Once your ostomy has been created, your surgeon or wound ostomy continence nurse (a WOC nurse specializes in ostomy care) will teach you to attach and care for a pouch called an ostomy appliance.
An ostomy appliance, or pouch, is designed to catch eliminated fecal material (stool).
The pouch is made of plastic and is held to the body with an adhesive.
The adhesive, in turn, protects the skin from moisture.
The pouch is disposable and is emptied or changed as needed.
The system is quite secure; accidents are not common, and the pouches are odor-free.
Your bowel movements will naturally empty into the pouch.
The frequency and quantity of your bowel movements will vary, depending on the type of ostomy you have, your diet, and your bowel habits prior to surgery.
You may be instructed to modify your eating habits in order to control the frequency and consistency of your bowel movements.
If the ostomy is a colostomy, irrigation techniques may be learned which allow for increased control over the timing of bowel movements.￼
An ostomy appliance is a plastic pouch, held to the body with an adhesive skin barrier, that provides secure and odor-free control of bowel movements.

Will other people know that I have an ostomy?
Not unless you tell them.
An ostomy is easily hidden by your usual clothing.
You probably have met people with an ostomy and not realized it.

Where will the ostomy be?
An ostomy is best placed on a flat portion of the abdominal wall.
Before undergoing surgery to create an ostomy, it is best for your surgeon or WOC nurse to mark an appropriate place on your abdominal wall not constricted by your belt-line.
A colostomy is usually placed to the left of your navel and an ileostomy to the right.

Will my physical activities be limited?
The answer to this question is usually no.
Public figures, prominent entertainers, and even professional athletes have ostomies that do not significantly limit their activities.
All your usual activities, including active sports, may be resumed once healing from surgery is complete.

Will an ostomy affect my sex life?
Most patients with ostomies resume their usual sexual activity.
Many people with ostomies worry about how their sexual partner will think of them because of their appliance.
This perceived change in one's body image can be overcome by a strong relationship, time and patience.
Support groups are also available in many cities.

What are the complications of an ostomy?
Complications from an ostomy can occur.
Most, like local skin irritation are typically minor and can be easily remedied.
Problems such as a hernia associated with the ostomy or prolapse of the ostomy (a protrusion of the bowel) occasionally require surgery if they cause significant symptoms.
Weight loss or gain may affect the function of an ostomy.
Living with an ostomy will require some adjustments and learning, but an active and fulfilling life is still possible and likely.
Your colon and rectal surgeon and WOC nurse will provide you with skills and support to help you better live with your ostomy.

Constipation

Constipation is a symptom that has different meanings to different individuals.
Most commonly, it refers to infrequent bowel movements, but it may also refer to a decrease in the volume or weight of stool, the need to strain to have a movement, a sense of incomplete evacuation, or the need for enemas, suppositories or laxatives in order to maintain regularity.
For most people, it is normal for bowel movements to occur from three times a day to three times a week; other people may go a week or more without experiencing discomfort or harmful effects.
Normal bowel habits are affected by diet.
The average American diet includes 12 to 15 grams of fiber per day, although 25 to 30 grams of fiber and about 60 to 80 ounces of fluid daily are recommended for proper bowel function.
Exercise is also beneficial to proper function of the colon.
About 80% of people suffer from constipation at some time during their lives, and brief periods of constipation are normal.
Constipation may be diagnosed if bowel movements occur fewer than three times weekly on an ongoing basis.
Widespread beliefs, such as the assumption that everyone should have a movement at least once each day, have led to overuse and abuse of laxatives.
Eating foods high in fiber, including bran, shredded wheat, whole grain breads and certain fruits and vegetables will help provide the 25 to 30 grams of fiber per day recommended for proper bowel function.

What causes constipation?
There may be several, possibly simultaneous, causes for constipation, including inadequate fiber and fluid intake, a sedentary lifestyle, and environmental changes.
Constipation may be aggravated by travel, pregnancy or change in diet.
In some people, it may result from repeatedly ignoring the urge to have a bowel movement.
More serious causes of constipation include growths or areas of narrowing in the colon, so it is wise to seek the advice of a colon and rectal surgeon when constipation persists.
Individuals with spinal cord injuries frequently experience problems with constipation.
Constipation may be a symptom of diabetes.
Constipation may also be associated with scleroderma, or disorders of the nervous or endocrine systems, including thyroid disease, multiple sclerosis, or Parkinson's disease.

When should I see a doctor about constipation?
Any persistent change in bowel habit, increase or decrease in frequency or size of stool or an increased difficulty in evacuating warrants evaluation.
Whenever constipation symptoms persist for more than three weeks, you should consult your physician.
If blood appears in the stool, consult your physician right away.

How can the cause of constipation be determined?
Constipation may have many causes, and it is important to identify them so that treatment can be as simple and specific as possible.
Your doctor will want to check for any anatomic causes, such as growths or areas of narrowing in the colon.
Digital examination of the anorectal area is usually the first step, since it is relatively simple and may provide clues to the underlying causes of the problem. Examination of the intestine with either a flexible lighted instrument or barium x-ray study may help pinpoint the problem and exclude serious conditions known to cause constipation, such as polyps, tumors, or diverticular disease.
If an anatomic problem is identified, treatment can be directed toward correcting the abnormality.
Other tests may identify specific functional causes to help direct treatment.
For example, marker studies, in which the patient swallows a capsule containing markers that show up on x-rays taken repeatedly over several days, may provide clues to disorders in muscle function within the intestine.
Other physiologic tests evaluate the function of the anus and rectum.
These tests may involve evaluating the reflexes of anal muscles that control bowel movements using a small plastic catheter, or x-ray testing to evaluate function of the anus and rectum during defecation.
In many cases, no specific anatomic or functional causes are identified and the cause of constipation is said to be non specific.

How is constipation treated?
The vast majority of patients with constipation are successfully treated by adding high fiber foods like bran, shredded wheat, whole grain breads and certain fruits and vegetables to the diet, along with increased fluids. Your physician may also recommend lifestyle changes.
Fiber supplements containing indigestible vegetable fiber, such as bran, are often recommended and may provide many benefits in addition to relief of constipation.
They may help to lower cholesterol levels, reduce the risk of developing colon polyps and cancer, and help prevent symptomatic hemorrhoids.
Fiber supplements may take several weeks, possibly months, to reach full effectiveness, but they are neither harmful nor habit forming, as some stimulant laxatives may become with overuse or abuse.
Other types of laxatives, enemas or suppositories should be used only when recommended and monitored by your colon and rectal surgeon.
Designating a specific time each day to have a bowel movement also may be very helpful to some patients.
In some cases, bio-feedback may help to retrain poorly functioning anal sphincter muscles.
Only in rare circumstances are surgical procedures necessary to treat constipation.
Your colon and rectal surgeon can discuss these options with you in greater detail to determine the best treatment for you.

Irritable bowel syndrome

Irritable bowel syndrome (IBS) is a common disorder that may affect over 15% of the general population.
It is sometimes referred to as spastic colon, spastic colitis, mucous colitis or nervous stomach.
IBS should not be confused with other diseases of the bowel such as ulcerative colitis or Crohn's disease.
IBS is a functional disorder where the function of the bowels may be abnormal but no structural abnormalities exist.

What are the symptoms of IBS?
People with IBS may experience abdominal pain and changes in bowel habits - either diarrhea, constipation, or both at different times.
Symptoms associated with IBS include abdominal cramps, fullness or bloating, abnormal stool consistency, passage of mucous, urgency or a feeling of incomplete bowel movements.

What causes IBS?
The symptoms of IBS seem to occur as a result of abnormal functioning or communication between the nervous system and the muscles of the bowel.
This abnormal regulation may cause the bowel to be irritated or more sensitive.
The muscles in the bowel wall may contract too forcefully or too weakly, too slowly or rapidly at certain times.
Although there is no physical obstruction, a patient may perceive cramps or functional blockage.

What role does stress play in IBS?
IBS is not caused by stress.
It is not a psychological or psychiatric disorder, however emotional stress may contribute to IBS.
Many people may experience nausea or diarrhea when nervous or anxious.
While we may not be able to control the effect stress has on our intestines, reducing the sources of stress in our lives may help to alleviate the symptoms of IBS.

How can I tell if the problem is IBS or something else?
A careful medical history and physical examination by a colon and rectal surgeon or other physician are essential to exclude more serious disorders.
Tests may include blood tests, stool tests, visual inspection of the inside of the colon with flexible sigmoidoscopy or colonoscopy, and x-ray studies.
Fever, anemia, rectal bleeding and unexplained weight loss are not symptoms of IBS and need to be evaluated by your physician.

How is IBS treated?
Understanding that IBS is not a serious or life-threatening condition may relieve anxiety and stress, which often contribute to the problem.
Stress reduction, use of behavioral therapy, biofeedback, relaxation or pain management techniques can help relieve the symptoms of IBS in some individuals.
Use of a diary may help to identify certain foods or other factors that cause symptoms.
Mild to moderate symptoms can often be managed by dietary changes.
Your physician may recommend avoiding meals that are too large or high in fatty or fried foods.
Caffeine or alcohol may also cause cramps or diarrhea.
Some types of sugar, such as sorbitol commonly used as a low calorie sweetener and fructose, found naturally in honey and some fruits may be poorly absorbed by the gut and cause cramping and diarrhea.
Gas producing foods such as beans, cabbage, cauliflower, broccoli, brussel sprouts and onions may cause bloating and increased discomfort in people with IBS.
Increasing dietary fiber may help to improve IBS symptoms.
Soluble fiber such as that found in citrus fruits, flaxseeds and legumes may help soften stool and lessen the severity of cramps.
Insoluble fiber such as cellulose, cereals and bran can absorb water as it moves through the digestive tract and lessen diarrhea.
In some people too much fiber can cause discomfort.
Adding fiber to the diet gradually with adequate amounts of liquids may eliminate the discomfort.
Individuals with moderate to severe IBS may benefit from prescribed medication.
Medications can help to control the symptoms of IBS but they do not cure the condition.
Medications act directly on the intestinal muscles to help the contractions return to normal.
Antidepressants in low doses have been shown to be helpful in some with IBS.

How long does the treatment take to relieeve symptoms?
Relief of IBS Symptoms is often a slow process.
It may take six months or more for definite improvement to be appreciated.
Patience is extremely important in dealing with this problem.
The tendency for the intestine to respond to stress will always be present.
With attention to proper diet and in some cases, use of appropriate medications, the symptoms of IBS can be greatly improved or eliminated.

Can IBS lead to more serious problems?
IBS does not cause cancer, bleeding or inflammatory bowel diseases, such as ulcerative colitis.

Contacts

Informations request

Franco Corno Doctor performs specialist examinations at his studio located in Via Arnaldo da Brescia 59 in Turin.
For booking a visit or more informations, please contact in following ways.

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Privacy Policy

Information pursuant to Article 13 Legislative Decree 196/03.
Published in the Official Gazette on 29th July 2003, General Series n.174, Ordinary Supplement n.123/L.
The above law governs the confidentiality of personal data and imposes a series of obligations on whoever processes data belonging to others.

By data processing the above law means any operation or series of operations, with or without electronic tools, concerning databases, accounts charges and others,
filling in tax substitution forms relative to anyone who is or is not an employee, the collection, recording, organising, storing, consulting, processing, amending, selecting, extraction, comparison,
use, interconnection, blocking, communicating, distributing, cancelling and destroying the data, even if not recorded in a database, completing software you order from us and websites ordered from us,
repairing computers and data they contain, including the system password and protections, and any other operation expressly envisaged by the activities our company performs.

In relation to the following listed positions where you may have to relate with our company:

supply contracts for tangible and intangible goods and services

commercial relations and collaboration of any nature

information or communications through newsletters of any kind or species

We inform you that the data about your company and individuals you assign to act on your behalf, are indispensable to enable us to pursue our normal operations involved with the above relations,
and therefore it is obligatory that we receive the relative data.
Refusal to provide said data means we would be unable to proceed with the services indicated.

All the requested data are compulsory.
When processing, we could come across data that the Privacy Law defines sensitive, as they could reveal the health, membership to trade unions, religious or philosophical beliefs.
Consequently we ask your express written consent to process the data.
The data are mainly processed using electronic and digital methods, stored on both computerised and printed files, or any other method that is accessible only for the authorised personnel,
in compliance with the minimum security measures given by technical regulations for minimum security measures, Annex B with the Privacy Law.

Our company uses IP address tracking technology and cookies to track the visits to the site, in particular:

the IP addresses are collected of all the visitors who visit our website; the collected data are used to manage our company's technical-administrative matters,
to diagnose any technical problems and to prevent intrusion and abuse of our services

our company may use cookies to improve the availability of our services, by associating a cookie to the visitor

Cookies are also used to determine the amount of traffic through our website and to trace your profile when you order our services,
to calculate the discounts and to manage any promotions that may be applicable to your account.
Visitors to the site can deactivate the Cookies function in their browser, but in certain cases this could cause malfunctions with the site.
For information about the use of cookies refer to Directive 2009/136/CE.
For more information about the advertisements of Google Adwords and Remarketing refer to Google Advertising Regulations.

The data you provide may be communicated or distributed to enable proceeding with the contract agreements with our company, for purposes related to them, for purposes relating to the display of references,
for commercial and promotional activities for our company products; furthermore the data may be communicated to:

studio or company staff who are processing managers or operators to enable managing the service you request;
said staff has been correctly trained into personal data security and privacy laws

The Inland Revenue, Tax Police, Finance Police, Labour Inspectors and, generally, all those other authorities responsible for controlling the correctness of the requirements for the above purposes

Category Associations and C.A.A.F. to provide the services listed in the above purposes, and professional studios we appoint for data processing

Data processing involves appointing certain people who have specific duties and responsibilities.
In particular:

the data processing operators are employees or workers with Franco Corno

The data in question are processed:

on any type of printed or digital means

by authorised and constantly identified people, who are duly trained and aware of the limitations imposed by current law

with the undertaking to maintain the data up to date, eliminating any obsolete, unnecessary or irrelevant data

with the undertaking to adopt the organisation and security measures envisaged by law, to guarantee the person's privacy and prevent undue access by any unauthorised parties

To enable fully understanding the question, please remember that Articles 7, 8, 9 of the Consolidated Text expressly protect the rights of the person concerned.
Below we give Article 7 of the Privacy Law (right to access personal data and other rights).
The person concerned has the right to confirmation whether their personal data exists or not, even if not yet registered, and the communication of the data in an intelligible form.

The person concerned has the right to know:

where the personal data originated

the purpose and method of processing

to logic applied in the case of digital processing

the details of the holder, managers and appointed representative as per Article 5(2)

the parties or categories that the personal data could be communicated to or who could learn of the data in their capacity as appointed delegate in the area, as managers or operators

The person concerned has the right:

to have the data updated, rectified or integrated if they wish

to have the data deleted, transformed into anonymous form or blocked if they are processed in violation of law,
including the data that do not need archiving for the purposes for which they were collected or processed

confirmation that the operations have been notified, including their contents, to the parties who have received the data,
unless this requirement is impossible or requires means that are out of proportion with respect to the protected right

The person concerned has the right to oppose, all or part:

their data being processed if they have legitimate reasons, even if the data are relative to the purpose for which they were collected

the processing of their personal data for sending advertising or direct sales materials, for market surveys and for commercial communications